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This chapter delineates the developmental trauma disorder (DTD) diagnosis proposed by the National Child Traumatic Stress DSM-V Taskforce. The numerous clinical expressions of the damage resulting from childhood interpersonal trauma are currently relegated to a whole variety of seemingly unrelated comorbidities, such as conduct disorder, attention-deficit hyperactivity disorder (ADHD) and separation anxiety. The chapter discusses the effects of childhood interpersonal trauma on brain activity, self-awareness and social functioning. Several large-sample studies have examined the causal relationship between childhood interpersonal trauma and DTD symptoms. These studies have documented the correlations of age of first trauma exposure, trauma severity and duration of exposure with DTD symptoms. Contemporary neuroscience research suggests that effective treatment needs to involve learning to modulate arousal, learning to tolerate feelings and sensations by increasing the capacity for interoception and learning that, after confrontation with physical helplessness, it is essential to engage in taking effective action.
The case study by Dr. Schechter presents a fascinating account of a 29-year-old mother presenting in a hospital with her two children (5 years and 8 months, respectively), with the younger child exhibiting seizure-like symptoms at arrival. As the case study unfolds, the reader learns that the mother and her older child also suffer from seizure-like symptoms. Despite efforts by the doctors to identify a medical cause for these seizures, no medical explanation for these symptoms can be found. Over the course of her life, the mother had been diagnosed with a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and conversion disorder (non-epileptic seizures). It becomes evident that she had suffered repeated and severe physical, sexual, and emotional abuse during her early childhood and adolescence. Although she reports that her children have not been exposed to any severe trauma, the children exhibit similar symptoms, including PTSD-like symptoms and non-epileptic seizures. Mother and children seem to have benefitted from psychotherapeutic intervention. In summary, two interesting phenomena have occurred: (1) after being exposed to severe stress early in her life, the mother developed a variety of psychiatric and medically unexplained somatic symptoms; and (2) these symptoms have been passed on from one generation to the next. The mechanisms underlying these phenomena are unclear and difficult to illuminate. The author of the case study thoroughly examines the potential psychological mechanisms translating trauma experienced early in life into somatic symptoms and the subsequent transmission of these symptoms from mother to child.
Kristin M. Penza, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia,
Christine Heim, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia,
Charles B. Nemeroff, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
Considerable evidence exists to suggest that traumatic events contribute toward vulnerability for major depression throughout the lifespan (Brown & Harris, 1993; Finlay-Jones & Brown, 1981; Kendler, Karkowski, & Prescott, 1999). However, the timing of the trauma may constitute an especially important variable in the development of long-term vulnerabilities toward depression and other psychiatric disorders including posttraumatic stress disorder (PTSD). Traumatic events occurring early in life appear to result in persistent alterations in neurobiological stress systems, increasing one's vulnerability to develop major depression. These early-life stress-induced changes include neuroendocrine, neurochemical, and neuroanatomical alterations. Increasing data derived from clinical and preclinical studies lend support to the view that these neurobiological changes associated with trauma experienced early in life occur after undue stress during particular critical developmental periods. These studies also support the important contribution of early-life traumas in the development of symptoms of depression and anxiety. In addition, this neurobiological vulnerability secondary to early-life trauma may permanently increase susceptibility to depression by rendering individuals more sensitive to stress throughout their adult life. Women are particularly vulnerable to depression; approximately twice as many women (12%) as men (7%) endure a depressive episode each year (Nolen-Hoeksema,; 1987). Lifetime risk of depression is also higher for women; 21% of women and 13% of men in the United States will experience an episode of major depression in their lifetime (Kessler et al., 1994). Higher exposure of women to early life trauma might contribute to this gender-related risk (Weiss, Longhurst, & Mazure, 1999).
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